Grandmothers raising grandchildren: managing, balancing and maintaining family relationships.

Most grandparents raising grandchildren are embedded in a network of family members who either help them carry out the caregiving task or complicate that role. This study examined how grandmothers described family relationships, that is, with the grandchild's parents, grandmother's spouses/partners, and other relatives. Data were drawn from 457 weekly journal entries submitted by 129 grandmother caregivers. Using thematic analysis, a three-person team coded using NVIVO 12. Grandmothers described three overarching relationship themes: managing conflicted relationships with the grandchild's parents, balancing relationships with their spouse/partner, and maintaining relationships with other relatives. Implications for practice are provided.

Choose who's in your circle: how women's relationship actions during and following residential treatment help create recovery-oriented networks.

Women in recovery from substance use disorders often have difficulty establishing recovery-supportive networks. This exploratory study uses qualitative thematic analysis to examine how 88 women in recovery describe the actions they take to manage their personal social networks 12 months after intake into residential substance use treatment. Participants describe disconnecting or limiting contact with recovery-endangering people and adding recovery-supportive people to their networks as primary relationship actions for maintaining recovery. Their actions to build recovery-supportive networks can provide a focus for clinical work to help them become integrated into their communities.

Maternal and Paternal Warmth Impact Recovery Support and Social Network Composition for Substance Dependent African American and Non-African American Women.

Poor early relationship experiences during the first 16 years of life may negatively impact adults' capacity to establish and utilize social support (Suchman, McMahon, Slade, & Luthar, 2005). This is especially of concern for women with substance use disorders (SUD) for whom social support is associated with recovery maintenance and treatment retention (Gregoire & Snively, 2001). The purpose of this study was to examine the influence of early relationship experiences, specifically paternal and maternal warmth, on recovery related social support and personal network characteristics among African American (AA) and non-AA women in treatment for SUD. Data were collected from 254 women in substance abuse treatment, 146 AA and 108 non-AA. Ordinal logistic, Poisson or multiple linear regressions were fitted to predict the impact of maternal and paternal warmth during childhood on adult social network composition and recovery support. Greater maternal warmth was associated with greater recovery-specific social support for both AA (ß = 0.12) and non-AA (ß = 0.15) women. Paternal, but not maternal, warmth significantly predicted the number of social network members who supported recovery for non-AA women (AOR = 1.04), and number of network members who used drugs and alcohol for AA women (IRR = 0.99). Developmental experiences associated with fathers appear to affect different domains of adult functioning than those associated with mothers, and those effects are different for AA versus non-AA women. Attention to these differences may inform culturally relevant substance abuse prevention and treatment efforts.

Formal and Informal Concrete Support and Discharge Disposition among Women in Substance Abuse Treatment in the U.S.

The purpose of this study is to examine the relative contribution and the relationships between formal (treatment related members) • informal (family members) concrete support and discharge disposition. A total of 172 women interviewed upon intake in one of 3 counties funded substance abuse treatment programs in Cleveland, Ohio. Hierarchical logistic regression was performed to assess the impact of formal concrete support and informal concrete support on the likelihood of a discharge disposition of completed treatment. Formal concrete support showed a statistically significant contribution to discharge disposition, while informal concrete support did not. Findings of this study highlight the importance of formal concrete support. Future research should continue to expand our knowledge of how support from formal treatment services interacts with support from informal (family) networks.

Recovery support mediates the relationship between parental warmth and quality of life among women with substance use disorders.

PURPOSE: Historically, recovery from substance use disorders (SUD) has focused exclusively on the use or non-use of the addictive substance(s). More recently, SAMSHA [1] has defined recovery in a more holistic way, using quality of life (QoL) as a measure of recovery for individuals with substance use and mental health disorders. However, little is known about the myriad experiences that inform and affect QoL for individuals with substance use disorders. Using an attachment informed stress-buffering framework, the purpose of this study was to examine the contribution of parental warmth and recovery support to QoL among women in substance abuse treatment. METHODS: Linear regression and bootstrapping were used to examine direct and mediated effects of parental warmth and recovery support on QoL among 318 women recruited from three inner-city women-only addiction treatment programs. Relationships were assessed across three domains of quality of life: physical, psychological, and social. RESULTS: Parental warmth and recovery support were directly associated with psychological and social QoL, when controlling for the influence of trauma symptoms. Recovery support mediated the relationship between parental warmth and QoL across psychological and social QoL domains. CONCLUSIONS: Findings suggest that interventions that focus on attachment-related constructs to enhance recovery support may improve quality of life among women with SUD.

Parenting Efficacy and Support in Mothers With Dual Disorders in a Substance Abuse Treatment Program.

OBJECTIVE: Approximately 73% of women entering treatment for substance use disorders are mothers of children younger than 18, and the high rate of mental health disorders among mothers with substance use disorders increases their vulnerability to poor parenting practices. Parenting efficacy and social support for parenting have emerged as significant predictors of positive parenting practices among families at risk for child maltreatment. The purpose of the current study was to examine the impact of parenting support and parenting efficacy on the likelihood of out-of-home placement and custody status among the children of mothers with dual substance use and mental health disorders. METHODS: This study examined the impact of parenting efficacy and assistance with childcare on the likelihood of child out-of-home placement and custody status among 175 mothers with diagnosed dual substance and mental health disorder and in treatment for substance dependence. Logistic regression was utilized to assess the contributions of parenting efficacy and the number of individuals in mothers' social networks who assist with childcare to the likelihood of out-of-home placement and custody loss of children. Parenting efficacy was also examined as a mediator using bootstrapping in PROCESS for SPSS. RESULTS: Greater parenting efficacy was associated with lower likelihood of having at least one child in out-of-home placement (B = -.064, SE = .029, p = .027) and lower likelihood of loss of child custody (B = -.094, SE = .034, p = .006). Greater number of children in the 6 to 18 age range predicted greater likelihood of having at least one child in the custody of someone else (B = .409, SE = .171, p = .017) and in out-of-home placement (B = .651, SE = .167, p < .001). In addition, mothers who identified as African American were less likely to have a child in out-of-home placement (B = .927, SE = .382, p = .015) or to have lost custody of a child (B = -1.31, SE = .456, p = .004). Finally, parenting efficacy mediated the relationship between parenting support and likelihood of out-of-home placement (effect = -.0604, SE = .0297, z = 2.035, p = .042) and between parenting support and likelihood of custody loss (effect = -.0332, SE = .0144, z = -2.298, p = .022). CONCLUSIONS: Implications for practice include the utilization of personal network interventions, such as increased assistance with childcare, and increased attention to efficacy among mothers with dual disorders.

Personal Network Structure and Substance Use in Women by 12 Months Post Treatment Intake.

INTRODUCTION: Women with substance use disorders enter treatment with limited personal network resources and reduced recovery support. This study examined the impact of personal networks on substance use by 12 months post treatment intake. METHODS: Data were collected from 284 women who received substance abuse treatment. At 6 month follow up, composition, support availability and structure of personal networks were examined. Substance use was measured by women's report of any use of alcohol or drugs. Hierarchical multivariate logistic regression was conducted to examine the contribution of personal network characteristics on substance use by 12 months post treatment intake. RESULTS: Higher numbers of substance using alters (network members) and more densely connected networks at 6 month follow-up were associated with an increased likelihood of substance use by 12 months post treatment intake. A greater number of isolates in women's networks was associated with decreased odds of substance use. Women who did not use substances by 12 months post treatment intake had more non-users among their isolates at 6 months compared to those who used substances. No association was found between support availability and likelihood of substance use. CONCLUSIONS: Both network composition and structure could be relevant foci for network interventions e.g. helping women change network composition by reducing substance users as well as increasing network connections. Isolates who are not substance users may be a particular strength to help women cultivate within their network to promote sustained sobriety post treatment.

Personal network recovery enablers and relapse risks for women with substance dependence.

We examined the experiences of women in treatment for substance dependence and their treatment providers about personal networks and recovery. We conducted six focus groups at three women's intensive substance abuse treatment programs. Four coders used thematic analysis to guide the data coding and an iterative process to identify major themes. Coders identified social network characteristics that enabled and impeded recovery and a reciprocal relationship between internal states, relationship management, and recovery. Although women described adding individuals to their networks, they also described managing existing relationships through distancing from or isolating some members to diminish their negative impact on recovery. Treatment providers identified similar themes but focused more on contextual barriers than the women. The focus of interventions with this population should be on both internal barriers to personal network change such as mistrust and fear, and helping women develop skills for managing enduring network relationships.

The Effects of Organizational Culture on Mental Health Service Engagement of Transition Age Youth.

Nationwide, there is a growing concern in understanding mental health service engagement among transition age youth. The ecological perspective suggests that there are multiple barriers to service engagement which exist on varying levels of the ecosystem. Based on the socio-technical theory and organizational culture theory, this study examined the impact of organization-level characteristics on perceived service engagement and the moderating role of organizational culture on practitioner-level characteristics affecting youth service engagement. A cross-sectional survey research design was used to address the research questions. The data were collected from 279 practitioners from 27 mental health service organizations representing three major metropolitan areas in Ohio. Hierarchical linear modeling was used to address a nested structure. Findings revealed that location of organization, service setting, and organizational culture had significant effects on the continuation of services. In addition, the relationship between service coordination and resource knowledge and service engagement was moderated by organizational culture.

Impact of trauma symptomatology on personal networks among substance using women.

BACKGROUND: Interpersonal trauma poses challenges and complications to the development and maintenance of personal networks of substance using women. Few studies have examined its effects on personal network support availability and quality of relationships, limiting our understanding of the social context in which substance using women with a history of trauma are embedded. METHODS: Women with substance use disorders (SUD) who received treatment at three county-funded, women-only intensive treatment programs (N=375) were interviewed at intake and at follow ups 1, 6, and 12 months later. A network software program, EgoNet, elicited 25 network members per respondent, social support availability, and the quality of network relationship at each assessment. Trauma symptomatology was assessed with Trauma Symptom Checklist-40 at intake. RESULTS: Findings from longitudinal mixed model analyses indicated that higher levels of trauma symptomatology were associated with both a negative, critical quality and less closeness in network relationships over the 12 month study period. However, trauma symptoms were not related to the number of network members reported as providing emotional, concrete, or sobriety support. Effects of trauma symptoms on the support availability in the network and the quality of network relationships were consistent over the follow-up period. CONCLUSIONS: Findings highlight the potential role of trauma symptoms in determining the quality of relationships within personal networks among women with SUD, suggesting the need for routine mapping of network relationships throughout treatment.

Changes in personal networks of women in residential and outpatient substance abuse treatment.

Changes in personal network composition, support and structure over 12 months were examined in 377 women from residential (n=119) and intensive outpatient substance abuse treatment (n=258) through face-to-face interviews utilizing computer based data collection. Personal networks of women who entered residential treatment had more substance users, more people with whom they had used alcohol and/or drugs, and fewer people from treatment programs or self- help groups than personal networks of women who entered intensive outpatient treatment. By 12 months post treatment intake, network composition improved for women in residential treatment; however, concrete support was still lower and substance users are still more prevalent in their networks. Network composition of women in outpatient treatment remained largely the same over time. Both groups increased cohesiveness within the network over 12 months. Targeting interventions that support positive changes in personal networks may heighten positive long term outcomes for women entering treatment.

Impact of Dual Disorders, Trauma, and Social Support on Quality of Life Among Women in Treatment for Substance Dependence.

OBJECTIVE: Women with dual disorders report lower levels of social support than women with substance dependence alone, and lower levels of social support have been associated with lower quality of life among individuals with substance use disorders. However, little is known about the impact of trauma symptoms and violence exposure on quality of life for women with dual disorders. The purpose of this study was to examine the impact of dual disorders, trauma, and social support related to recovery on various domains of quality of life among women in substance abuse treatment. METHODS: This study utilized multiple standardized measures and hierarchical ordinary least squares regression to examine quality of life, trauma, and social support in women with dual disorders. Four domains of quality of life were measured (Physical, Psychological, Social, and Environmental Domains). Participants (N=369) were recruited from three inner city women only addiction treatment programs. IRB approval was obtained prior to sample recruitment. RESULTS: Presence of a dual disorder was significantly associated with lower quality of life in the Physical and Psychological domains. However, this difference was no longer significant when trauma symptoms were added to the model. Trauma symptoms and Support for Recovery significantly predicted quality of life across all four domains and Friends Support for Abstinence across three domains. CONCLUSIONS: Findings suggest that the presence of a dual disorder in women may indicate a history of trauma. They also support the importance of both friend's support for abstinence and recovery support as predictors of quality of life in women with dual disorders. Interventions that focus on social support and quality of life in treatment with women with substance use disorders may potentially enhance treatment outcomes.

Substance Abuse Treatment Stage and Personal Networks of Women in Substance Abuse Treatment.

This study examines the relationship among 4 treatment stages (i.e., engagement, persuasion, active treatment, relapse prevention) and the composition, social support, and structural characteristics of personal networks. The study sample includes 242 women diagnosed with substance dependence who were interviewed within their first month of intensive outpatient treatment. Using EgoNet software, the women reported on their 25 alter personal networks and the characteristics of each alter. With one exception, few differences were found in the network compositions at different stages of substance abuse treatment. The exception was the network composition of women in the active treatment stage, which included more network members from treatment programs or 12-Step meetings. Although neither the type nor amount of social support differed across treatment stages, reciprocity differed between women in active treatment and those in the engagement stage. Networks of women in active treatment were less connected, as indicated by a higher number of components, whereas networks of women in the persuasion stage had a higher degree of centralization, as indicated by networks dominated by people with the most ties. Overall, we find social network structural variables to relate to the stage of treatment, whereas network composition, type of social support, and sociodemographic variables (with a few exceptions) do not relate to treatment stage. Results suggest that social context, particularly how social contacts are arranged around clients, should be incorporated into treatment programs, regardless of demographic background.

Prospective patterns and correlates of quality of life among women in substance abuse treatment.

BACKGROUND: Quality of life (QOL) is increasingly recognized as central to the broad construct of recovery in substance abuse services. QOL measures can supplement more objective symptom measures, identify specific service needs and document changes in functioning that are associated with substance use patterns. To date however, QOL remains an under investigated area in the addictions field, especially in the United States. METHODS: This study examines patterns and predictors of QOL at 1 and 6 months post treatment intake among 240 women enrolled in substance abuse treatment in Cleveland, Ohio. The World Health Organization Quality of Life (WHOQOL-BREF) measure was used to assess physical, psychological, social and environmental domains. Hierarchical multiple regressions were conducted to identify correlates of QOL at 6 months post treatment intake. RESULTS: All QOL domains across the follow up time points improved significantly. However, QOL scores across domains remained below those of healthy population norms. Trauma symptoms significantly predicted Physical and Psychological QOL. Among treatment process variables, alcohol use was the sole significant factor associated with QOL and only for Environmental QOL. Recovery support and friends support for abstinence were consistently associated with QOL across all four domains. IMPLICATIONS: This study suggests the usefulness of the WHOQOL measure as an indicator of functioning in substance abusing populations. Findings underline the importance of helping women deal with trauma symptoms and develop support for recovery. Further research is needed on the longitudinal relationship between QOL and substance use patterns.

Likelihood of asking for help in caregivers of women with substance use or co-occurring substance use and mental disorders.

Family members are important to the well-being of their relatives with substance use disorders or co-occurring substance use and mental disorders. Many caregivers experience high levels of burden, negatively impacting their capacity to provide support to their ill family member. The Andersen health care utilization model (Andersen & Newman, 1973, 2005) was used to identify the impact of predisposing, enabling and need factors hypothesized to predict caregivers' likelihood of asking for help and support with their caregiving role. The sample include 82 women recruited from outpatient or inpatient substance abuse treatment centers and 82 family caregivers nominated by these women. Findings showed that almost half of caregivers were unlikely to ask for help. Multiple regression analysis found that two need variables were statistically signficant predictors of caregivers' likelihood to ask for help. Caregivers who had higher subject burden (worry) and caregivers who provided more assistance with daily living were more likely to ask for help. It is suggested that case managers assess the amount of worried family caregivers' experience because their worries may provide the motivation to ask for help or to participate in help when it is offered to them.

Social Support: A Mixed Blessing for Women in Substance Abuse Treatment.

Using a personal social network framework, this qualitative study sought to understand how women in substance abuse treatment describe their network members' supportive and unsupportive behaviors related to recovery. Eighty-six women were interviewed from residential and outpatient substance abuse treatment programs. Positive and negative aspects of women's social networks were assessed via open-ended questions. Analysis was guided by grounded theory techniques using three coders. The findings extend classic social support concepts such as emotional, tangible, and informational support. Practice implications are presented in light of the potential roles network members may play in substance use and recovery.

Predictors of Depressive Symptomatology in Family Caregivers of Women With Substance Use Disorders or Co-Occurring Substance Use and Mental Disorders.

This study utilized a stress-process model to examine the impact of having a female family member with substance use or co-occurring substance use and mental disorders on family caregivers' depressive symptomatology. Participants were 82 women receiving substance abuse treatment and the family member providing the most social support for each woman. Greater caregiver depressive symptomatology was predicted by greater care recipient emotional problems, less care recipient social support, and poor caregiver health. Implications of findings for treatment and future research are discussed.

Children's roles in the social networks of women in substance abuse treatment.

This study examined the status of children and the types of support available from children as reported by women in substance abuse treatment. Findings indicate that children are viewed as sources of social support to women on treatment. Children were viewed as providing as much sobriety support to respondents as that provided by adult network members. In addition, both children living with the respondent and children in the care of others were viewed as providers of specific types of social support. Implications are drawn for practice and research.